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Wiki Billing medicare as a secondary
- Thread starter hartvn
- Start date
What state are you in? I can help if your in Southern Ca. If not, you'll need to go on your Medicare website and locate MSP link. It should tell you what needs to be documented on the CMS-1500 for and what address it gets mailed to.
There should be no difference except that MSPQ will be required for facility charges. Each state has a different processor, sometimes diff for Part A and Part B, and if you are doing Medicare specific services like the AWE it would bill w/the Gcode and be denied by the primary in most cases. Medicare laws would be universal, but since all the insurances contract differently there can always be a reason to vary. Plus with different billing systems, in some cases they just can't split the claims appropriately going from a commercial payor to Medicare. That is usually not a problem unless you are billing out of a PBB facility, CAH, Rural or HB facility. i suppose it would depend on your specific problem with the billing?
smontague
Networker
It took me a little while to figure this out too, but once you get all the pieces it's pretty simple. Check out the CMS website for MSP billing instructions. Generally you have to submit secondary claims electronically now, I think unless you are a really small practice...I forget the exact details. I submit all ours electronically. You just need to make sure you have the appropriate value code listed to show why they have Medicare as the secondary coverage and you have to list all the payment/adjustment info from the primary payer remittance.
teresabug
Expert
it depends on whether you are billing on a CMS 1500 or UB04 claim form. If billing on a CMS 1500 there is no specific code you have to have anywhere. And unless your practice has gotten special permission to submit on paper, you have to bill it EDI. Make sure your primary insurance payment and/or adjustment amount has been posted correctly to your software. Your software vendor should already have in place the appropriate field templated for your claims to transmit EDI.